SUCCESSFUL OUTCOME OF CRYOSURGERY IN PATIENTS WITH GRANULOMA-ANNULARE

Several therapeutic methods have been employed in the management of lo calized granuloma annulare (GA), with varying degrees of success. We p erformed a prospective trial to evaluate the efficacy, cosmetic result s, and safety of cryosurgical treatment in GA. Thirty-one patients wit h localized GA were treated by cryosurgery, using the contact method. Nitrous oxide (-86 degrees C) or liquid nitrogen (-196 degrees C) were used as refrigerants, and were applied with closed probes; each lesio n was treated with one freeze-thaw cycle of 10-60 s per session. If ne cessary, treatment was repeated after 20-30 days. Resolution of the le sions was obtained in all patient's, and in 25 of 31 patients (80.6%) they resolved after a single freeze-thaw cycle. Relapse occurred in on ly one of 11 patients who were followed for more than 2 years, and thi s occurred 16 months after treatment. Excellent cosmetic results were obtained in 14 of 28 patients who were eligible for evaluation (50%), and good results in 11 (39.3%). The cosmetic result obtained by cryosu rgery with nitrous oxide was independent of the size of the lesion, wh ereas in the group of patients treated with liquid nitrogen a better c osmetic result was obtained with smaller lesions (comparison of lesion s less than or equal to 2.40 cm(2) with those > 2.40 cm(2); P=0.04). T he duration of the lesion, its location, previous treatment with anoth er method, and the number of treatment sessions, did not have any infl uence on the cosmetic result. The treatment was generally well tolerat ed. Blister formation occurred in all patients. Atrophic scars occurre d in four of 19 patients (21.1%), all of whom had been treated with li quid nitrogen. Cryosurgery is effective and safe in the treatment of l ocalized GA, and excellent cosmetic results may be achieved. We propos e that the use of nitrous oxide as a refrigerant, with a single freeze -thaw cycle of 20 s, covering the entire surface of small lesions and the active rim of larger lesions (greater than or equal to 4 cm in dia meter) is the optimal therapeutic regimen.